Detailed Abstract
[BP Oral Presentation 1 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP OP 1-8] MINIMALLY INVASIVE SPLEEN-PRESERVING DISTAL PANCREATECTOMY: SPLENIC VESSEL-PRESERVING PROCEDURE IS A “DOUBLE-EDGED SWORD” IN LEFT-SIDED PORTAL HYPERTENSION
Yusuke WATANABE 1, Kohei NAKATA 1, Toshiya ABE 1, Noboru IDENO 1, Naoki IKENAGA 1, Masafumi NAKAMURA 1
1 Department of Surgery And Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
Background : Spleen-preserving distal pancreatectomy (SPDP) involves two procedures, splenic vessel preservation (Kimura) and splenic vessel resection (Warshaw). This study evaluated the outcomes after minimally invasive (MI) Kimura and Warshaw SPDP.
Methods : The medical records of 114 consecutive patients who underwent MI-SPDP (Kimura group, n=53; Warshaw group, n=61) between 2012 and 2022 were retrospectively reviewed.
Results : Most short-term outcomes were comparable between the groups, except for splenic infarction. The prevalence of radiological splenic infarction was significantly lower in the Kimura group than in the Warshaw group (6% vs. 44%; P<0.01), although splenic infarctions were clinically harmless. The incidences of perigastric and gastric intraluminal venous dilatation confirmed on CT during follow-up were significantly lower in the Kimura group than in the Warshaw group (45% vs. 84%; P<0.01 and 21% vs. 41%; P=0.01, respectively). Postoperative changes in splenic volume were significantly smaller in the Kimura group than in the Warshaw group (median, 18% vs. 28%; P=0.04). However, 40% of patients in the Kimura group developed postprocedural splenic venous stenosis during follow-up; most of these patients had left-sided portal hypertension (LSPH), and postoperative splenic volume changes were significantly greater than those in patients after the Warshaw procedure (median, 42% vs. 28%, P=0.04).
Conclusions : The short- and long-term outcomes of patients after both procedures are comparable. The Kimura procedure has the potential risk of postoperative splenic venous stenosis during the follow-up period, which causes LSPH. Establishing patient selection criteria and suitable surgical procedures to prevent splenic venous stenosis after the MI-Kimura procedure is needed.
Methods : The medical records of 114 consecutive patients who underwent MI-SPDP (Kimura group, n=53; Warshaw group, n=61) between 2012 and 2022 were retrospectively reviewed.
Results : Most short-term outcomes were comparable between the groups, except for splenic infarction. The prevalence of radiological splenic infarction was significantly lower in the Kimura group than in the Warshaw group (6% vs. 44%; P<0.01), although splenic infarctions were clinically harmless. The incidences of perigastric and gastric intraluminal venous dilatation confirmed on CT during follow-up were significantly lower in the Kimura group than in the Warshaw group (45% vs. 84%; P<0.01 and 21% vs. 41%; P=0.01, respectively). Postoperative changes in splenic volume were significantly smaller in the Kimura group than in the Warshaw group (median, 18% vs. 28%; P=0.04). However, 40% of patients in the Kimura group developed postprocedural splenic venous stenosis during follow-up; most of these patients had left-sided portal hypertension (LSPH), and postoperative splenic volume changes were significantly greater than those in patients after the Warshaw procedure (median, 42% vs. 28%, P=0.04).
Conclusions : The short- and long-term outcomes of patients after both procedures are comparable. The Kimura procedure has the potential risk of postoperative splenic venous stenosis during the follow-up period, which causes LSPH. Establishing patient selection criteria and suitable surgical procedures to prevent splenic venous stenosis after the MI-Kimura procedure is needed.
SESSION
BP Oral Presentation 1
Room 2 3/27/2025 3:30 PM - 4:30 PM